論文 - 辻　哲也

The internal consistency and predictive validity of the Stroke Impairment Assessment Set (SIAS)

Tsuji Tetsuya, Liu Meigen, Sonoda Shigeru, Domen Kazuhisa, Chino Naoichi

Journal of Stroke and Cerebrovascular Diseases 9 （ 2 SUPPL. ） 229 - 230 2000年

ISSN  1052-3057

Comorbidities in stroke patients as assessed with a newly developed comorbidity scale

Liu M., Tsuji T., Tsujiuchi K., Chino N.

American Journal of Physical Medicine and Rehabilitation 78 （ 5 ） 416 - 424 1999年09月

ISSN  0894-9115

　概要を見る

We previously reported reliability and validity of our newly developed comorbidity scale (CS) for stroke outcome research based on a retrospective sample. The objectives of this study were to cross-validate the comorbidity scale in a new prospective sample and to investigate longitudinal changes of the comorbidity scale during hospitalization. In a prospective sample of 175 stroke patients admitted to five nonacute rehabilitation hospitals in Japan, we analyzed the frequency and grading of comorbidities and compared the comorbidity scale with demographic data, impairment as assessed with the Stroke Impairment Assessment Set (SIAS), and disability as measured with the Functional Independence Measure (FIM(SM)). The results were compared with our previous retrospective study. We also studied longitudinal changes by measuring the comorbidity scale on admission, 2 wk later, and at discharge of 67 patients. As a result, the comorbidity scaling was significantly lower in the prospective sample, and it increased at the second measurement and then plateaued. Among the comorbidities, hypertension ranked first, followed by shoulder pain, and diabetes mellitus. Similar to our previous retrospective study, the comorbidity scale correlated positively with age and length of stay and correlated negatively with the SIAS motor item scores and the FIM scores. In conclusion, the present study suggested concurrent and predictive validity of the comorbidity scale in a prospective sample as well and clarified the comorbidity characteristics of stroke inpatients.

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Bridging activity as a mode of stress testing for persons with hemiplegia

Tsuji T., Liu M., Tsujiuchi K., Chino N.

Archives of Physical Medicine and Rehabilitation 80 （ 9 ） 1060 - 1064 1999年09月

ISSN  0003-9993

　概要を見る

Objective: To establish a stress testing protocol for hemiplegic persons using graded bridging activity at the rates of 3 to 24 repetitions per minute. Design: Paired comparisons of exercise parameters and admission and discharge data between hemiplegic and control groups. Setting: Inpatient rehabilitation program of a tertiary rehabilitation center in Japan. Patients: (1) Preliminary study: five hemiplegic patients. (2) Comparison with normal subjects. 39 hemiplegic patients and 10 age-matched controls. (3) Study of reproducibility five hemiplegic patients and five controls. (4) Longitudinal changes 30 hemiplegic patients. Main Outcome Measures: Oxygen consumption (Vo<inf>2</inf>), heart rate (HR), and HR oxygen coefficient (regression coefficient between HR and Vo<inf>2</inf>). Results: The testing protocol was applicable to 88.6% of hemiplegic patients. The relationship between HR and Vo<inf>2</inf> was linear, and HR oxygen coefficient was significantly lower in hemiplegic patients than the controls. The intraclass correlation coefficients were greater than 0.7 for Vo<inf>2</inf>, HR, and HR oxygen coefficient, indicating satisfactory reproducibility HR decreased longitudinally for the same stress levels and the HR oxygen coefficient increased, indicating improved fitness level. Conclusions: The bridging activity protocol is a useful mode for stress-testing hemiplegic persons. The linearity between HR and VO<inf>2</inf> with this protocol allows us to use the indices of fitness obtainable from this relationship.

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ADL structure for nondisabled Japanese children based on the functional independence measure for children (WeeFIM(TM))

Tsuji T., Liu M., Toikawa H., Hanayama K., Sonoda S., Chino N.

American Journal of Physical Medicine and Rehabilitation 78 （ 3 ） 208 - 212 1999年05月

ISSN  0894-9115

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The Functional Independence Measure for Children (WeeFIM(TM)) instrument was developed, based on the FIM(TM) instrument, to assess disability in children aged 6 mo to 7 yr. Normative data are reported for American and Japanese children, and it is increasingly used for the disabled. Our purpose was to confirm scale quality and to determine the difficulty pattern of the WeeFIM in Japan. The WeeFIM was measured in 225 children (113 girls and 112 boys) aged 6 mo to 7 yr without developmental delays. The scores were converted to an interval scale by Rasch analysis, which assumes unidimensionality of the measurement items, determines the degree of the fit to the assumption, and decides item difficulty. When the WeeFIM items were divided into two groups of motor and cognitive items to minimize misfit, the degree of misfit was acceptable, except for eating, bladder management, tub/shower transfer, and comprehension. For the motor items, grooming, bathing, and bladder control were more difficult, and stairs, bed/chair transfer, and walk or wheelchair were easier. Concerning the cognitive items, expression and comprehension were easier, and problem-solving was most difficult. When we compared item difficulty patterns in the four age groups (6-21 mo, 22-45 mo, 46-62 mo, and 63-100 mo), we found no differences, except in toilet transfer. It was more difficult for younger children, possibly because of its different pattern of chronological change, which shows rapid changes from dependent to independent levels over a short period of time. Our study confirmed the scale quality of the WeeFIM instrument with Rasch analysis and demonstrated the difficulty pattern of the WeeFIM in nondisabled Japanese children.

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Osteoporosis in hemiplegic stroke patients as studied with dual-energy x-ray absorptiometry

Liu Meigen, Tsuji Tetsuya, Higuchi Yoshiko, Domen Kazuhisa, Tsujiuchi Kazuhito, Chino Naoichi

Archives of Physical Medicine and Rehabilitation 80 （ 10 ） 1219 - 1226 1999年

ISSN  0003-9993

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<p>Objectives: To compare bone mineral densities (BMDs) of the affected and unaffected limbs in stroke patients at multiple sites; to study longitudinal changes during a 3-month rehabilitation program; and to relate BMDs to demographic, impairment, and disability variables. Design: Descriptive study. Setting: Tertiary rehabilitation center. Patients: One hundred four consecutive hemiplegic inpatients, 69 men, age 56.5 ± 13.2yrs, 47 with left- sided brain lesion. Median days from onset to admission and median length of stay days were 83 and 105.5, respectively. Main Outcome Measures: BMDs of proximal humerus, distal radius, femoral neck, and calcaneus bilaterally, and third lumbar vertebra, measured with dual-energy x-ray absorptiometry (DXA), were compared between affected and unaffected sides at admission and discharge. Results: Stroke Impairment Assessment Set (SIAS) motor scores, Functional Independence Measure (FIM) scores, grip strength, and awake/sleep heart rate counts (activity index) improved significantly at discharge. Affected/unaffected BMD ratios were 88.3% to 98.4% at admission and 79.6% to 98.8% at discharge, lowest for the humerus. Discharge/admission ratios were 89.1% to 97.8% for the affected and 97.4% to 100% for the unaffected side. All BMDs were intercorrelated (R = .438 to .873). They correlated significantly with age, body weight, grip strength, FIM scores, and activity index. Factors selected to explain BMD with multiple regression analysis differed according to the site and timing of the measurement. Conclusions: BMDs of the affected side were lower and most marked in the humerus. Longitudinally, not only the affected but the unaffected BMDs decreased. Age, sex, duration of stroke, anthropometric measurements, motor paralysis, muscle strength, and activity level contributed differently to bone loss according to the site and timing of the measurement.</p>

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Newly developed short behavior scale for use in stroke outcome research

Tsuji Tetsuya, Liu Meigen, Sonoda Shigeru, Domen Kazuhisa, Tsujiuchi Kazuto, Chino Naoichi

American Journal of Physical Medicine and Rehabilitation 77 （ 5 ） 376 - 381 1998年09月

ISSN  0894-9115

　概要を見る

<p>This study was designed to examine the scale quality of our newly developed short behavior scale and to identify its role in predicting the functional outcome of stroke patients. The short behavior scale consists of six items that assess cognitive function related to the daily behavioral status of a patient in activities of daily living and exercise. It can be scored quickly through observation of a patient's behavior. We assessed 190 stroke inpatients, who had a mean age of 61 years. The mean days and length of stay from onset were 47.3 and 138.2, respectively. We examined internal consistency with the Cronbach's alpha coefficient. Interrater reliability was tested by having two examiners evaluate 30 patients independently. We studied how the short behavior scale correlated with the admission Functional Independence Measure, Mini-Mental State Examination scores, and speech and visuospatial functions. We also studied how the short behavior scale contributed to the prediction of discharge Functional Independence Measure raw scores with stepwise multiple regression analysis. In another group of 116 patients, we cross-validated our predictive equation. The Cronbach's alpha coefficient was 0.88. The intraclass correlation coefficient was 0.84 for total score. The short behavior scale correlated significantly with cognitive Functional Independence Measure scores and Mini-Mental State Examination scores. We could explain 70.8% of the variance of discharge Functional Independence Measure scores from the Short Behavior Scale, days from onset to admission, age, speech scores, and admission Functional Independence Measure scores. Stability of the predictive equation was shown in cross-validation to a second sample of 116 patients. In conclusion, our newly developed short behavior scale proved reasonable and would be useful to enhance the precision of outcome prediction in stroke rehabilitation.</p>

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ADL structure for stroke patients in Japan based on the functional independence measure

Tsuji T., Sonoda S., Domen K., Saitoh E., Liu M., Chino N.

American Journal of Physical Medicine and Rehabilitation 74 （ 6 ） 432 - 438 1995年

ISSN  0894-9115

　概要を見る

The difficulty patterns of FIM (Functional Independence Measure) in Japan were determined and compared with patterns found in the United States to assess whether FIM can be used for worldwide comparisons of ADL (the activities of daily living). The FIM was measured for 190 stroke patients in several hospitals throughout Japan. The scores at admission and discharge were converted to an interval scale by Rasch analysis. Right and left brain lesion patients were analyzed separately. The FIM items were divided into two groups: motor items and cognitive items to minimize misfit. A degree of misfit was acceptable, except for bowel and bladder management, stairs, bathing, and expression. Motor items, eating, and bowel and bladder management were the easiest; stairs, bathing, and tub/shower transfers were the most difficult. The difficulty patterns of patients with left and right hemisphere lesions were almost identical. Bathing and tub/shower transfer were more difficult for Japanese patients than for those studied in the United States. Concerning the cognitive items, expression was easiest for patients with right hemisphere lesions but most difficult for those with left hemisphere lesions. Social interaction was easier for Japanese patients with left hemisphere lesions than the other patients. The item difficulty patterns in Japan differs slightly from those in the United States because of cultural differences. As countries show different patterns of difficulty, we must be careful when making international comparisons of FIM data converted by Rasch analysis.

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